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End-of-life costs on the rise for patients with HF in U.S. and Canada
Kaul P. Arch Intern Med. 2010;doi:10.1001/archinternmed.2010.365.
Unroe KT. Arch Intern Med. 2010;doi:10.1001/archinternmed.2010.371.
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The cost of care during the last 6 months of life is increasing among patients with HF in both the United States and Canada, according to data from two studies published in the Archives of Internal Medicine. Both studies aimed to gain information on the use of health care resources at the end of life and the associated costs.
Researchers in the U.S. conducted a retrospective cohort study of 229,543 patients with HF who died between 2000 and 2007. All patients were Medicare beneficiaries. The researchers collected data for all-cause hospitalizations, ICU days, skilled nursing facility stays, home health, hospice, durable medical equipment, outpatient physician visits and cardiac procedures during the last 180 days of life.
About 80% of patients were hospitalized during the last 6 months of life, the researchers reported. The number of days spent in the ICU increased from 3.5 to 4.6 (P<.001), and more patients spent time in skilled nursing facilities in 2007 than in 2000 (P<.001). In addition, hospice use during the study period increased from 19% of patients to nearly 40% (P<.001). The cost associated with the increase in hospice use was also higher: The mean cost of hospice per patient rose from $964 to $2,594.
Rising costs in Canada
Researchers in Canada found similar results for cost, but the rate of hospitalization and in-hospital deaths decreased among elderly patients with HF.
The Canadian study included 33,144 patients aged ≥65 years with HF who died between 2000 and 2006. Costs associated with all-cause hospitalization, intensive care, ED visits, outpatient visits, physician office visits and outpatient drugs during the last 180 days of life were analyzed.
According to the study, more than 80% of hospitalizations in the last 6 months of life were not HF-related. During the study period, the percentage of patients hospitalized for HF in the last 6 months of life decreased from 84% to 76.2% (P<.001); however, the mean length of stay was consistent. Conversely, the use of outpatient care was higher, particularly among patients who died in later years of the study compared with those who died earlier (52.8% in 2000 to 69.8% in 2006; P<.001).
Despite a decline in hospitalizations, the researchers reported a $4,000 increase in the mean hospitalization costs per patient ($21,995 in 2002 to $26,186 in 2006). According to the researchers, the mean cost per patient in 2006 was five times the per capita expenditure in Alberta that year.
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